POS0562 FREQUENCY OF IN-PERSON AND VIRTUAL VISITS FOR RHEUMATOID ARTHRITIS: ANALYSIS OF THREE YEARS OF VISIT DATA BEFORE AND AFTER THE COVID PANDEMIC
Authors: D. Solomon, M. Jiang, L. Santacroce, R. Rudin
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Few data have been published regarding appropriate visit frequency in rheumatoid arthritis (RA). While guidelines suggest more frequent visits early in disease and when disease is active, there are few descriptions of visit frequency. Also, visit frequency may have changed during the COVID pandemic. <h3>Objectives</h3> We examined visit frequency and types of visits (in-person versus virtual) for patients with RA seen at one US academic medical center during the 18 months before COVID lockdown, 3 months of lockdown, and 18 months after. <h3>Methods</h3> We extracted data from 11 clinically focused rheumatologists' practices at an academic medical center and created a sample of 257 patients with rheumatologist-diagnosed RA. The study period of interest encompassed the 18 months prior to COVID pandemic (Nov 2018 – Feb 2020), the 3 months of COVID lockdown (rheumatology clinic closed except emergencies, March – May 2020), and the 18 months after lockdown (June 2020 – Sept 2021); patients were required to have ≥1 visit prior and ≥1 visit after the lockdown to be included. We estimated: 1) monthly volume of in-person and virtual visits (telephone-only or video) for the RA study cohort, and 2) annual median patient visit frequencies. In addition, we assessed predictors of a patient's visit volume using multivariable linear regression over the pre- and post-lockdown periods. Variables tested included RA disease characteristics (CRP, serologic status, and DMARD use), patient demographics and comorbid conditions, and rheumatologist. <h3>Results</h3> Patient characteristics are shown in the <b>Table 1</b>. Patients' median age was 58y, 84% were female; 82% used any DMARD; 20% used only csDMARDs; and 61.5% used a t/bDMARD. Visit volume over 39 months is illustrated by visit type in the <b>Figure 1</b>. In the 18 months prior to the COVID pandemic, median annual visit frequency per patient was 2.7 (IQR 2.0, 3.3), with an overall median monthly visit volume of 61 (IQR 51, 58). Overall visit volume remained consistent post-lockdown: median annual visit frequency per patient 2.7 (IQR 2.0, 3.3), with an overall median monthly visit volume of 68 (50, 73). As expected, median monthly visit volume was reduced during the lockdown period: 58 (IQR 51, 65); but it rebounded to pre-pandemic levels within 9 months. During the first 3 months post-lockdown, virtual visits comprised 61% of all visits (51% video, 10% telephone only). By the 12th month post-lockdown, virtual visits comprised 11% of all visits; all were video. The following variables associated with increased patient visit volume during the pre- and post-lockdown periods (36 months): older age and fewer comorbidities. When specific rheumatologists were added as fixed effects, these variables strengthened in their significance; additionally, several rheumatologists were associated with significant increases in visit volume. <h3>Conclusion</h3> The COVID pandemic caused a disruption in rheumatology practice with a rapid substitution of virtual visits. Office visit volume for RA rebounded relatively quickly in one US-based academic practice. Virtual visits were common during and immediately after lockdown but became less common over time. Several variables, unrelated to RA, were associated with visit volume. <h3>References</h3> None. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Daniel Solomon Grant/research support from: Abbvie, Amgen, CorEvitas, Janssen, Moderna, Max Jiang: None declared, Leah Santacroce: None declared, Robert Rudin: None declared.